The soluble receptor for AGEs

Two 2022 human studies on sRAGE, starting with one of hypoxia-related diseases:

“The receptor for advanced glycation end products is found on endothelial and inflammatory cell surfaces. It binds to circulating advanced glycation end products, activating a proinflammatory protein cascade that contributes to systemic oxidative stress and inflammation.

sRAGE is the soluble isoform of RAGE and acts as a protective decoy by buffering inflammatory ligands, decreasing inflammatory injury. Therefore, low levels of sRAGE are a biomarker of deficient inflammatory control.

We show that plasma concentrations of the anti-inflammatory molecule sRAGE are reduced in patients with chronic obstructive pulmonary disease (COPD) and in patients with obstructive sleep apnoea (OSA). Overlap of COPD and OSA does not lead to an additive effect.

Effective treatment by continuous positive airway pressure (CPAP) of subjects with obstructive apnoeas (with or without associated COPD) increases the level of sRAGE, while in healthy subjects and COPD without OSA, these levels do not change over time. This is the first study to investigate the effect of CPAP on plasma levels of sRAGE.” “Soluble RAGE in COPD, with or without coexisting obstructive sleep apnoea”

A second study introduced sRAGE isoforms:

“We explored associations of circulating levels of soluble RAGE, its endogenous secretory (esRAGE) and cleaved (cRAGE) isoforms, AGEs, and their respective ratios with 15-year all-cause mortality in type 2 diabetes. The potential prognostic value of sRAGE as a marker of disease and occurrence of adverse events seems to be suitable for individuals with chronic disease or multimorbidity, and not for the general population.

Baseline AGEs and sRAGE isoforms concentration were measured by ELISA in 362 patients with type 2 diabetes and in 125 age- and gender-matched healthy control subjects. At an average follow-up of 15 years, 130 deaths [in T2D subjects] were observed.

A nomogram based on age, sex, HbA1c, systolic blood pressure, and the AGEs/cRAGE ratio was built to predict 5-, 10- and 15-year survival in type 2 diabetes. Kaplan-Meier survival function for patients with type 2 diabetes grouped according to quartiles of the nomogram-based mortality risk score:

diabetes survival

An increase in the AGEs/cRAGE ratio was accompanied by a higher risk of all-cause mortality in patients with type 2 diabetes. The AGEs/cRAGE ratio led to a significant, albeit modest, improvement in the already established RECODe model of predicting 10-year all-cause mortality in type 2 diabetes based on age, sex, ethnicity, smoking, systolic blood pressure, history of major adverse cardiovascular events (MACE), HbA1c, total cholesterol, HDL-C, serum creatinine, and urinary albumin-to-creatinine ratio.

While none of the parameters was significantly associated with development of any complication in patients without complications at the time of enrollment, sRAGE was associated with the development of MACE over a 15-year follow-up in patients with type 2 diabetes who had no history of MACE at recruitment.” “Circulating levels of AGEs and soluble RAGE isoforms are associated with all-cause mortality and development of cardiovascular complications in type 2 diabetes: a retrospective cohort study”


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